There was a BMJ publication that came out on 6th June that prompted several headlines that suggested that “exercise doesn’t help depression”. But weeding out the study’s specific, detailed coverings to a media-friendly sound bite has resulted in the risk of people getting the wrong idea. The researchers, in fact, did not even make the test of exercise on people with depression.
This article will reveal what all the researchers did, the tests they ran and the increasing scrutiny that they faced afterward. It also proves the crucial need for a research to be done with more depth. There has, however, been a number of experts and doctors who suggest that exercise does help people with depression, who are also victims of obesity, cardiovascular disease or diabetes.
The BMJ study researchers hail from the Universities of Bristol, Exeter and the Peninsula College of Medicine and Dentistry. They were to uncover if adding a physical task/challenge with the “usual care” that patients with depression get through their general practitioners (GPs) in the UK, could maybe reduce the symptoms that they have or not.
This intervention, TREAD (Treatment of Depression with physical activity), is actually based off on a theory, and offers a trained facilitator who then helps with “individually tailored support and encouragement to engage in physical activity”, say the researchers. This type of research benefits healthcare providers to come up with decisions about the kind of services that would be best in primary care.
The people in charge of the researchers were hoping to test TREAD because even though there is proof to suggest exercise is advantageous to people having depression, it is usually from small, mild studies that examine programmes that the National Health Service (NHS) may not find practical to deliver.
TREAD has been devised to “improve long-term adherence to physical activity”, and a key feature is making sure patients select activities of their choice, catering to their specific needs and the activities they can execute in their own environments. The patients then get a three-time face to face meeting with their facilitator. This person is trained in motivational interactive techniques with up to 10 telephone calls.
In the BMJ study, this intervention went on for 6 to 8 months, where facilitators were hands-on for 4 months. It included 361 adult patients aged 18-69 who were diagnosed with depression at several different centers in the UK. One group got the usual care, and the other group was given the usual care plus TREAD. They were tracked for 12 months.
The exercise data was taken from the physical activity that the participants noted in their diaries. Some of them had on accelerometers which proved the reliability and accuracy of these entries. “Usual care” translates to them getting instructions from GP for their depression. The primary care included counseling, use of antidepressants, and “exercise on prescription”.
So a distinctive feature of this research work is that all patients had the freedom to take up prescribed exercise where some were given encouragement. Another feature was that the study was not weighing the effectiveness of exercise encouragement with the other forms of treatment like counseling and medication, it was sewed as an adjunct to these.
The recent government guidelines in the UK has advised the adults to do 150 minutes of moderate or vigorous physical activity every week, where researchers give an explanation: “The aspiration was for the participants [in the TREAD group] to engage in moderate or vigorous activity for 150 minutes a week in bouts of at least 10 minutes, but if that seemed unrealistic then the facilitator encouraged any increase in physical activity, whatever the intensity.”
Well, what the researchers found out about the participants of the TREAD intervention group did not gain much compared to the ones who got the usual care. For example, there was “no evidence that participants offered the physical activity intervention reported improvement in mood by the four-month follow-up point compared with those in the usual care group”. Moreover, they found,”there was no evidence that the intervention group reported a change in mood by the eight and 12-month follow-up points”.
There was absolutely no proof that the reduced antidepressant use in the TREAD group varied from the usual care only receiving group. To conclude their findings, the researchers had one thing to say:
“The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce the use of antidepressants compared with usual care alone.”
What the people in charge of the research did find was that the people involved with the TREAD group reported more physical activity in the follow-up time period. It showed that they continued this even after stopping their interactions with the facilitator. The concluding note was that it was not “useless” for depression, in contrast to the headlines. Their results could, however, be of help for healthcare solutions in primary care services.
The main author Melanie Chalder, from the University of Bristol’s School of Social and Community Medicine, released a statement to the press: “Numerous studies have reported the positive effects of physical activity for people suffering from depression but our intervention was not an effective strategy for reducing symptoms. However, it is important to note that increased physical activity is beneficial for people with other medical conditions such as obesity, diabetes and cardiovascular disease and, of course, these conditions can affect people with depression.” The next plan is to see if TREAD helps with other conditions.
National Institute for Health and Clinical Excellence (NICE) is in charge of setting the government guidelines. The last time this was revised happened all the way back in 2009 with suggestions that patients with mild to moderate depression must always be given group-based physical activity programmes,that is also supported by a competent facilitator, “guided by the person’s preference”, consisting of “typically of three sessions per week of moderate duration (45 minutes to 1 hour) over 10 to 14 weeks”.
Only time will tell whether the BMJ’s study will result in a change of these guidelines. A comment made by the NHS Choices article by Bazian has proved that it would not. Another group that analyzes healthcare plans released a statement: “This study assessed just one type of exercise intervention that involved facilitating greater activity levels. Therefore, this study does not tell us whether other types of support or exercise programme may have a positive effect on depression.”
They made a suggestion that the study could be of use to NHS staff that are in search of interventions that might benefit patients with the condition. There are many points that suggest that these findings would result in a need to change the guidelines as they are now outdated. For instance, in 2009, a Cochrane review has concluded that the then discoveries were weak and more or less not supportive of the notion that the treatment of depression can be helped by exercise.
Other reviews have also chimed in to say that the guidelines need to be altered and that the effect of exercise needs to be researched a bit more to make a concrete decision about its effects. Their concerns were produced by the Dutch paper that has been printed in BMC Public Health in January, suggesting that there is a need to see the long-term effect. The authors responded by saying, it was a “first well-conducted add-on randomised controlled high-quality trial into the effect of aerobic exercise on depression”.
They also express an interest in studying the effect of aerobic exercises like brisk walking and jogging to see what happens to depression and other conditions relating to it like metabolic syndrome. Moreover, exercises are cheap and usually do not have side-effects and “the introspective ability necessary for most psychotherapies”, claims the authors. It would not be so wrong to say that these discoveries are prompting the need for a more in-depth research regarding exercise and depression.
Even with many denying it, there are several experts and doctors that conclude and are supportive of the fact that exercise actually helps in treating depression. For example, in America, the Institute for Clinical Systems Improvement (ICSI), in their latest discoveries and research work on adults with severe cases of depression found that “physical activity and active patient engagement are also useful in easing symptoms of major depression”.
Journal of Family Practice article in 2010 claims “providing evidence-based answers from the Family Physicians Inquiries Network”, adding that “exercise alone reduces patient-perceived symptoms of depression as effectively as cognitive behavioral therapy or drugs”. In Victoria, Australia, the health authorities claim that exercise helps release serotonin plus builds up self-esteem as the patient takes up an active role in his/her progress. It ultimately leads to a healthy and positive social life.
Exercise also helps reduce overthinking and stress as we do not have time to think too much while staying active, improving cardiovascular fitness, helps maintain a healthy weight, and reduces cholesterol and blood pressure. NHS Choices website writes “exercise can help people recover from depression and prevent them from becoming depressed in the first place”, arguing that exercise is “especially useful for people with mild depression”.
They suggested that one must spend 150 minutes of moderately intense activity every week, slowly intensifying the intensity as you go along. Just a 15-minute walk could also help reduce stress. One good way for people with depression to get better is taking part in team sports, attending classes at a sports center or gym, or being active in their daily lives. “Anything that gets you off the couch and moving is an exercise that can help improve your mood,” the Mayo Clinic in the US has stated.